Mani Selvin Sundar Raj, Thomas Athul, Alam Rizwan, Lalwani Manish, Valson Anna T, Yadav Bijesh, Eapen Jeethu J, John Elenjickal E, Yusuf Sabina, Mukha Rajiv P, Rajadoss Muthu Krishna Pandian, Mercy Deborah, Alexander Suceena, Varughese Santosh, David Vinoi G
Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Nephrol. 2024 Jan-Feb;34(1):37-44. doi: 10.4103/ijn.ijn_407_22. Epub 2023 Jun 5.
There is a paucity of studies on asymptomatic bacteriuria (ASB) among kidney transplant recipients (KTR) in developing countries. This study assessed the clinical profile, risk factors, outcomes, and impact of treatment of ASB in KTRs with a normal genitourinary tract.
Consecutive KTRs from 2009 to 2018 with no clinical or radiological evidence of obstructive uropathy were included. Urinary tract infection (UTI) after ASB was defined as occurrence of cystitis, pyelonephritis, or urosepsis, with ASB being the first bacteriuric episode.
Seven hundred ten out of 794 patients with median follow up of 47 months were included. The mean age was 35.5 ± 12 years. Eighty-one patients (11.4%) developed ASB at a median of 25 days (IQR 10, 134.5). Fifty-three percent and 4.9% of ASB episodes were extended-spectrum beta-lactamase (ESBL) positive and carbapenem-resistant organisms, respectively. Eighteen patients (32.1%) with early ASB (<3 months) and 5 (20%) with late ASB developed UTI on follow-up. Fifty-five percent of early and 16% of late ASB episodes were treated, with no significant difference observed in the risk of development of UTI when compared to untreated ASB episodes.
The incidence of ASB as first bacteriuric episode in our cohort was 11.4%, with there being significant antimicrobial resistance. Female gender, pretransplant UTI, and delayed graft function were independently associated with development of ASB. Treatment of ASB episodes either early or late did not decrease the risk of development of UTI.
发展中国家肾移植受者（KTR）中关于无症状菌尿（ASB）的研究较少。本研究评估了泌尿生殖道正常的KTR中ASB的临床特征、危险因素、结局及治疗影响。
纳入2009年至2018年连续的无梗阻性尿路病临床或影像学证据的KTR。ASB后发生的尿路感染（UTI）定义为膀胱炎、肾盂肾炎或尿脓毒症的发生，ASB为首次菌尿发作。
794例患者中有710例纳入研究，中位随访时间为47个月。平均年龄为35.5±12岁。81例患者（11.4%）在中位时间25天（四分位间距10，134.5）发生ASB。ASB发作中分别有53%和4.9%为超广谱β-内酰胺酶（ESBL）阳性和耐碳青霉烯类微生物。18例（32.1%）早期ASB（<3个月）和5例（20%）晚期ASB患者在随访中发生UTI。55%的早期和16%的晚期ASB发作接受了治疗，与未治疗的ASB发作相比，UTI发生风险无显著差异。
在我们的队列中，ASB作为首次菌尿发作的发生率为11.4%，存在显著的抗菌药物耐药性。女性、移植前UTI和移植肾功能延迟与ASB的发生独立相关。早期或晚期治疗ASB发作均未降低UTI的发生风险。
